The incidence of aseptic loosening and the potential impact of strut allografts in revision total elbow arthroplasty

Hypothesis and background: Revision total elbow arthroplasty (TEA) is challenging because of poor bone stock. We hypothesized that strut allografts providing structural reinforcement would reduce occurrence of aseptic loosening after revision TEA. Methods: We retrospectively analyzed patients who underwent revision TEA at our hospital between 2005 and 2022. Patients were excluded from the study if the bone loss was too severe and required allograft-prosthetic composite reconstruction, if the implant stem was not replaced, or if the follow-up period was <2 years. Cortical thinning was defined as follows: (1) the overall cortical thickness was <50% compared to the contralateral side or (2) the cortex was locally thinner than the surrounding area by <50% on the radiograph. Implant stability and aseptic loosening were analyzed on the final radiograph. The patients were divided into a strut allograft group (n = 9) and a nongraft group (n = 9) for comparison. Results: Eighteen patients were analyzed during the study period. There were 8 males and 10 females with an average age of 66 years (range, 39-82 years). The average follow-up period was 61 months (range, 24-183). Cortical thinning was observed in 11 patients (61%) at the time of revision TEA. There were no differences in pain visual analog scale, Quick Disabilities of the Arm, Shoulder, and Hand score, and range of motion between the 2 groups. Aseptic loosening occurred in 1 patient (11%) in the strut allograft group and in 3 patients (33%) in the nongraft group; however, this difference was not statistically significant. In nongraft group, 3 patients developed aseptic loosening and subsequently underwent rerevision arthroplasty. In strut allograft group, 1 patient had aseptic loosening; however, the patient remained asymptomatic and observed without revision. Conclusion: Cortical thinning occurred in 61% of the patients undergoing revision TEA. Aseptic loosening is the most common complication of revision TEA, observed in 22% of the cases. The use of strut allografts did not show a significant association with a lower incidence of aseptic loosening. However, it may still have clinical value.